Widely-used epilepsy drug may raise risk for birth defects

Pregnant women who take topiramate for epilepsy, or any other condition, during their first trimester may boost the chance their child will be born with a cleft lip or palate.

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HealthDay News

A widely-used epilepsy drug, when used by pregnant women during their first trimester, may increase risk for birth defects, according to new research. Photo by agnumohansson/Shutterstock

WEDNESDAY, Dec. 27, 2017 -- A common anti-seizure drug may pose a birth defect problem for pregnant women, a new study warns.

Researchers found that pregnant women with epilepsy who take the drug topiramate during their first trimester may boost the risk that their child will be born with a cleft lip or cleft palate.

That risk increase specifically applies to women with epilepsy, who typically take topiramate at an average daily dosage of 200 milligrams.

However, topiramate is also sometimes taken at a lower dosage to control migraines, treat bipolar disorder or in combination with other drugs to lose weight. Pregnant women who take it for these reasons also may face an increased risk.

The study found that pregnant women who take it during their first trimester at an average dosage of 100 mg for reasons other than epilepsy boost their child's risk for a cleft lip or palate by roughly 50 percent.

The findings were reported online Dec. 27 in the journal Neurology.

The greater risk among women with epilepsy is "likely due to the higher doses of topiramate when used for controlling seizures," study author Dr. Sonia Hernandez-Diaz said in a journal news release. She's a researcher with the Harvard T.H. Chan School of Public Health in Boston.

The researchers compared those who took topiramate during their first trimester at various doses, and for various purposes, with women who took no anti-seizure medication. They also compared taking topiramate with taking lamotrigine, another medication used to treat seizures.

Among the 1.3 million women not taking anti-seizure drugs, the rate of risk of having a baby with cleft lip or palate was 1.1 per 1,000. In the 2,800 mothers who took lamotrigine, the risk was 1.5 per 1,000. In the more than 2,400 mothers who took topiramate in the first trimester of pregnancy, the risk was 4.1 per 1,000.

Overall, the investigators calculated that topiramate taken at any dosage significantly raised the risk for cleft lip or palate, compared with lamotrigine or with taking no anti-seizure mediation. And higher doses led to higher risk, the study found.